Salivary bypass tube placement in esophageal stricture: A technical note and report of three cases

3Hypopharyngeal and cervical esophageal strictures can be caused by advanced malignancies, ingestion of caustic materials, or can follow surgery or radiation therapy. They cause marked dysphagia and consequently patients need nasogastric or gastrostomy tube feeding, with a remarkable impact on quality of life. To restore oral feeding, the stenosis can be progressively dilated by using rubber bougies of increasing diameter, and a Montgomery® Salivary Bypass Tube can then be inserted to maintain the obtained calibre. However, while its flexibility makes it easy to tolerate, it has the drawback of making insertion difficult because the tube tends to bend. The aim of this paper is to present a possible solution to this problem. A Montgomery® Salivary Bypass Tube was distally sutured to a Cook Airway Exchange Catheter® to simplify its initial insertion through a laryngoscope and following replacements. The catheter was then easily removed leaving the bypass tube in the correct position. In our experience, this innovative approach proved effective in facilitating Montgomery® Salivary Bypass Tube insertion in three patients, without risks for the patient, additional operative time or increase in costs.partially_openembargoed_20171215Tirelli, Giancarlo; Baruca, Roberto; Boscolo Nata, FrancescaTirelli, GIAN CARLO; Baruca, Roberto; BOSCOLO NATA, Francesc

Narrow band imaging in the intra-operative definition of resection margins in oral cavity and oropharyngeal cancer

Objectives: In oncological surgery, a three-dimensional resection 1.5\u20132 cm from the gross tumour edge is currently considered appropriate, and the status of resection margins is the most reliable indicator of radicality. Awareness of \u2018\u2018field cancerization\u2019\u2019 calls for a re-evaluation of the benchmarks of tumour resection; however, its identification is not simple because the dysplastic areas may be far from the main lesion and difficult to recognize macroscopically. New technologies such as narrow band imaging (NBI) could improve the detection of neoplastic and pre-neoplastic areas, ensuring more precise resections. The main purpose of this study was to investigate the value of NBI in detecting pre-cancerous areas and/or cancer around the tumour bulk intra-operatively, to achieve adequate resection of the tumour. Materials and Methods: The resection margins of 8 oral cavity and 8 oropharyngeal cancers were first drawn by macroscopic evaluation and then re-defined using NBI. Resections were performed following the NBI-drawing if extemporaneous histological examinations of the NBI-defined enlargements were positive for dysplasia or cancer. The number of clear margins was evaluated. Results: Resections margins were free of tumour or dysplasia at extemporaneous examination; on definitive histology, two patients had a margin positive for cancer and dysplasia, respectively. Among the NBI-defined enlargements, 25% were positive for dysplasia and 75% for cancer. The sensitivity, specificity, positive and negative predictive values were 100%, 88.9%, 100% and 87.5%, respectively. Conclusion: The method we propose could be useful for obtaining free surgical margins and reducing the potential development of tumour foci resulting from incomplete resection

Phenotypic Definition of the Progenitor Cells with Erythroid Differentiation Potential Present in Human Adult Blood

In Human Erythroid Massive Amplification (HEMA) cultures, AB mononuclear cells (MNC) generate 1-log more erythroid cells (EBs) than the corresponding CD34pos cells, suggesting that MNC may also contain CD34neg HPC. To clarify the phenotype of AB HPC which generate EBs in these cultures, flow cytometric profiling for CD34/CD36 expression, followed by isolation and functional characterization (colony-forming-ability in semisolid-media and fold-increase in HEMA) were performed. Four populations with erythroid differentiation potential were identified: CD34posCD36neg (0.1%); CD34posCD36pos (barely detectable-0.1%); CD34negCD36low (2%) and CD34negCD36neg (75%). In semisolid-media, CD34posCD36neg cells generated BFU-E and CFU-GM (in a 1 : 1 ratio), CD34negCD36neg cells mostly BFU-E (87%) and CD34posCD36pos and CD34negCD36low cells were not tested due to low numbers. Under HEMA conditions, CD34posCD36neg, CD34posCD36pos, CD34negCD36low and CD34negCD36neg cells generated EBs with fold-increases of ≈9,000, 100, 60 and 1, respectively, and maturation times (day with >10% CD36highCD235ahigh cells) of 10–7 days. Pyrenocytes were generated only by CD34neg/CD36neg cells by day 15. These results confirm that the majority of HPC in AB express CD34 but identify additional CD34neg populations with erythroid differentiation potential which, based on differences in fold-increase and maturation times, may represent a hierarchy of HPC present in AB

Is there a role for tumor volume in prediction of prognosis for oral cancer?

Purpose: New prognostic factors in oral squamous cell carcinoma (OSCC) (tumor-, host-, and environment-related) have been introduced recently to complete those traditionally considered. Among them, tumor volume (TV) could be the most interesting and applicable in clinical practice, considering the routine use of computed tomography in tumor staging. In this retrospective study we aimed to investigate whether a correlation exists among these new prognostic factors and survival outcomes. Meterials and methods: We collected data about 140 patients affected by OSCC who underwent primary surgery. Prognostic factors were collected and Overall Survival (OS), Disease Specific Survival (DSS) and Disease Free Survival (DFS) were estimated using Kaplan-Meier method; the Log-Rank test (Mantel-Cox) and Cox regression models were applied to investigate predictors of survival. Results: The 5-year OS, DSS and DFS were 73.6 %, 89.2 % and 75.2 % respectively. Nodal metastasis (pN+), relapse and American Society of Anesthesiologists ASA-II were found independent prognostic factors for OS, and significantly associated to worst DSS (p < 0.001). TV significantly correlated with higher relapse occurrence (p = 0.03). Conclusions: In our experience, lymph-node status, ASA classification and relapse significantly influenced DSS on univariate analysis. TV could represent an interesting additional parameter, since it significantly influenced DFS. However, prospective studies with standardized TV measurements and a greater number of patients are needed to validate this result

Intervento preventivo e terapeutico nell’osteoartrosi degli arti inferiori: revisione sistematica della letteratura.

Introduzione e obiettivo L’osteoartrosi (OA) è caratterizzata dalla degenerazione della cartilagine che provoca il cedimento strutturale e funzionale delle articolazioni sinoviali, principalmente attraverso un’alterazione regressiva e non infiammatoria della cartilagine. Questa patologia è una delle principali cause di disabilità in tutto il mondo, in gran parte a causa del dolore. L’obiettivo di questo studio è eseguire una revisione sistematica confrontando l’efficacia delle varie terapie riabilitative proposte per questa patologia, studiare l’importanza della prevenzione in soggetti maggiormente esposti ed evidenziare gli interventi di trattamento che apportano maggiori risultati al paziente. Materiali e metodi La ricerca della letteratura, condotta seguendo le linee guida internazionali PRISMA mediante la strategia PICO, è stata effettuata attraverso le banche dati Medline (via PubMed), Scopus, PEDro, LILACS e Trip Databse tra i mesi di Maggio e Giugno 2023. La letteratura presente è stata vagliata mediante la formulazione di diverse stringhe di ricerca: PubMed ((“Osteoarthrosis” [MeSH]) AND (“physiotherapy” [MeSH] OR (“rehabilitation” [MeSH] OR (“exercise” [MeSH])),  Scopus, LILACS e Trip Database (“Osteoarthrosis” AND (“physiotherapy” OR “rehabilitation” OR “ exercise”))  e su PEDro è stata utilizzata la stringa “Osteoarthrosis AND Rehabilitation”. Sono stati inclusi solo studi RCT in lingua inglese, pubblicati dal 2013 al 2023 che andassero a prendere in esame l’arto inferiore con un range di età da 55 a 70 anni non operati. Gli articoli duplicati sono stati eliminati mediante il software EndNote. Inizialmente sono stati selezionati gli articoli pertinenti in base al titolo, poi in base alla lettura dell’abstract e infine in base alla lettura del full text. Risultati Dopo l’inclusione sono stati selezionati 6 RCT con una popolazione affetta da osteoartrosi degli arti inferiori.  E’ stata valutata la qualità metodologica mediante la scala PEDro. Gli studi inclusi presentano mediamente un punteggio di 7.3. Sono emerse multiple strategie di trattamento: allenamento aerobico, esercizi di stretching dei muscoli dell’anca, esercizi di equilibrio statico e dinamico, esercizi di stabilità e resistenza, elettroterapia, ma è emerso che la maggior parte degli studi inclusi predilige l’esercizio di rinforzo muscolare. Discussione e conclusioni Alla luce dei risultati ottenuti da questa Revisione Sistematica, si ritiene necessario riconoscere gli interventi riabilitativi, attraverso la loro dimensione multidisciplinare, parte fondamentale del trattamento, importanti tanto quanto l’intervento farmacologico, per determinare un rallentamento nella progressione della patologia e un efficace controllo di quest’ultima. L’analisi di questi ultimi ci porta ad affermare che sarebbe necessario ampliare la ricerca tramite follow-up a lungo termine e aumentare la grandezza del campione

Frozen sections and complete resection in oral cancer surgery

OBJECTIVES: Although the reliability of frozen sections for the intraoperative assessment of complete tumour excision has been established, the best location for collection and the impact of the type of sampling are still debated. We retrospectively investigated the reliability of frozen sections when collected from the surgical bed as tissue strips representative of the whole superficial margin and as a bowl of tissue underlying the resection site for deep margin, and the possibility of relying on frozen section negativity to consider resections complete. MATERIALS AND METHODS: Frozen section reliability was calculated by comparing histology before and after formalin embedding and then categorised by sampling type, in 182 patients undergoing transoral resection of oral cancer. RESULTS: Comparing frozen and permanent histology, sensitivity, specificity and accuracy were 69%, 98% and 96%, respectively; categorisation by sampling type failed to produce statistically significant differences. Based on frozen section negativity after formalin embedding, complete resections were obtained in 91.7% of patients with multiple-strip and bowl frozen sections. CONCLUSION: Frozen sections collected as tissue strips and bowl are as reliable as point sampling in the intraoperative guidance of surgical resections. They effectively provide for margin enlargement, thereby increasing the surgeon's confidence that negative margins are clear

THE COURSE OF ASTHMA DURING PREGNANCY IN A RECENT, MULTICASE-CONTROL STUDY ON RESPIRATORY HEALTH

Background Over the years it has been widely stated that approximately one third of asthmatic women experience worsening of the disease during pregnancy. However, the literature has not been reviewed systematically and the meta-analytic reviews include old studies. This study aimed to examine whether the prevalence of worsening asthma during pregnancy is still consistent with prior estimate or it has been reduced. Methods A detailed Clinical Questionnaire on respiratory symptoms, medical history, medication, use of services, occupation, social status, home environment and lifestyle was administered to random samples of the Italian population in the frame of the Gene Environment Interactions in Respiratory Diseases (GEIRD) study. Only clinical data belong to 2.606 subjects that completed the clinical stage of the GEIRD study, were used for the present study. Results Out of 1.351 women, 284 self-reported asthma and 92 of them had at least one pregnancy. When we considered the asthma course during pregnancy, we found that 16 women worsened, 31 remained unchanged, 25 improved. Seven women had not the same course in the different pregnancies and 13 did not know. The starting age of ICS use almost overlaps with that of asthma onset in women with worsening asthma during pregnancy (19 years \ub11.4), unlike the other women who started to use ICS much later (30.3 years \ub112). In addition, the worsening of asthma was more frequent in women with an older age of onset of asthma (18 years \ub19 vs 13 years \ub110). Among women who completed the ACT during the clinical interview, the 50% of women who experienced worsening asthma during pregnancy (6/12) had an ACT score below 20. Conclusion Asthma was observed to worsen during pregnancy in a percentage much lower to that generally reported in all the previous studies. There is still room in clinical practice to further reduce worsening of asthma during pregnancy by improving asthma control, with a more structured approach to asthma education and management prepregnanc

Topical Steroids in Rhinosinusitis and Intraoperative Bleeding: More Harm Than Good?

The aim of this study was to assess whether the chronic preoperative administration of intranasal corticosteroids (INCs) in chronic rhinosinusitis with/without nasal polyposis (CRSwNP/CRSsNP, respectively) could significantly influence bleeding during functional endoscopic sinus surgery (FESS). We prospectively enrolled 109 patients (56 CRSwNP and 53 CRSsNP) candidate for FESS who underwent clinical evaluation and anamnestic data collection. They were allocated to 2 groups depending on whether or not they were chronic INC users, as declared at their first medical evaluation: chronic "INC users" represented the treated group, while "INC nonusers" formed the control group. Lund-Mackay and American Society of Anesthesiology (ASA) scores, blood loss expressed both in milliliters and using the Boezaart scale, operation time in minutes, pre- and postoperative 22-item Sino Nasal Outcome Scores (SNOT-22) were collected. Each sample underwent histopathological evaluation. The results showed that anamnestic information, Lund-Mackay, and SNOT-22 scores were similar between the 2 groups ( P > .05). The average blood loss expressed in milliliters and operative time were slightly, but not significantly, higher in the INC user group, while the Boezaart scores proved significantly higher in the INC users ( P = .038). No differences emerged between CRSwNP and CRSsNP within each group in terms of bleeding. The pathologist described common features in the majority (78%) of INC group samples: ectatic venules embedded in a fibrous stroma and hypertrophy of the arterial muscular layer. In our experience, despite the presence of NP, chronic preoperative administration of INCs was associated with increased intraoperative bleeding according the Boezaart scale although objective recordings of blood loss were not statistically different between the INC users and nonusers

Case report: Exploring under the tip of the iceberg: A case series of “self-limiting” multisystem inflammatory syndrome in children

Multisystem inflammatory syndrome in children (MIS-C) is a serious condition triggered by SARS-COV-2 infection, characterized by persistent fever, multiorgan dysfunction, and increased inflammatory markers. It requires hospitalization and prompt treatment, with nearly 60% of the cases needing intensive care and 2% fatality rate. A wide spectrum of clinical characteristics and therapeutic approaches has been reported in MIS-C. We describe a series of four patients with MIS-C, defined according to the current case definitions, with a self-limiting course and no need for immunomodulatory treatment (“self-limiting MIS-C”). Few data about self-limiting MIS-C are available to date and no information on medium- and long-term outcome of this subset of patients has been reported. Although limited in size, our experience provides new insights into the MIS-C syndrome, highlighting an underestimated aspect of the disease that may have significant therapeutic implications

Prognostic value of H-index in patients surgically treated for squamous cell carcinoma of the larynx.

OBJECTIVE: Recently, a novel host-related index, the Host-index (H-index), including both inflammatory and nutritional markers, has been described and observed to stratify prognosis in patients with squamous cell carcinoma (SCC) of the oral cavity more accurately than other host-related indexes This study aimed to investigate the prognostic performance of the H-index using pretreatment blood tests in patients receiving up-front surgery for SCC of the larynx. METHODS: This retrospective observational study included a multicenter series of consecutive patients with SCC of the larynx diagnosed between 1 January 2009 and 31 July 2018, whose pretreatment blood tests were available and included the parameters necessary for the calculation of neutrophil to lymphocyte ratio (NLR) and the H-index. Their association with disease-free survival (DFS) and overall survival (OS) was measured. RESULTS: A total of 231 patients were eligible for the present analysis (median [range] age, 68 [37-96] years; 191 [82.7%] men). The median follow-up was 73 months. In multivariable Cox proportional hazards regression models, increasing age (adjusted hazard ratio [aHR], 1.07 per year; 95% CI, 1.04-1.09), advanced pT stage (aHR = 1.71 95% CI: 1.07-2.71), and having close or positive surgical margins (aHR = 2.01; 95% CI: 1.21-3.33) were significantly associated with poor OS. Among blood parameters, a higher neutrophil count was a strong predictor of both worse DFS (aHR for recurrence/death = 2.34; 95% CI: 1.24-4.40) and OS (aHR for death = 2.67; 95% CI: 1.51-4.71). Among inflammatory blood indexes, while NLR was not significantly associated with DFS or OS, patients with H-index ≥8.37 showed a higher aHR for both recurrence/death (2.82; 95% CI: 1.65-4.79) and death (2.22; 95% CI: 1.26-3.89). CONCLUSION: In conclusion, the present study confirms the prognostic value of pretreatment H-index, an easily measurable inflammatory and nutritional index, in patients with SCC of the larynx. LEVEL OF EVIDENCE: III